Provider Demographics
NPI:1245950880
Name:OSTERKAMP, JONATHAN STEPHEN (PHARM D)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:STEPHEN
Last Name:OSTERKAMP
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HIGHLANDS BOULEVARD DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4385
Mailing Address - Country:US
Mailing Address - Phone:636-686-7400
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHLANDS BOULEVARD DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4385
Practice Address - Country:US
Practice Address - Phone:636-686-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016027153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty